Palliative and Supportive care

EGFRI-Related Skin Toxicity

Information, treatment algorithms and educational materials for healthcare professionals and patients about skin problems that may occur when being treated with anti-EGFR drugs

Multikinase Inhibitor Related Skin Toxicity

Information, treatment algorithms and educational materials for healthcare professionals and patients relating to the management of dermatological toxicities in patients treated with multikinase inhibitors.

Drug-Drug Interactions with Kinase Inhibitors

Information and education online resource for healthcare professionals on drug-drug interactions which can arise from the use of kinase inhibitors

Abstract

Introduction

Although very rare, cholangiocarcinoma is a highly lethal type of cancer that is often already locally advanced at time of diagnosis. Chemotherapy and surgery are the cornerstone of the treatment. The purpose of this study is to review our local experience with the staging and treatment of the different stages of cholangiocarcinoma.

Methods

We reviewed the charts of patients hospitalized at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) who were diagnosed with cholangiocarcinoma between 2002 and 2013. A retrospective analysis was performed to analyze diagnostic methods, staging at diagnosis, different treatment strategies and most importantly the survival rates between the studied groups. The survival rates were estimated with Kaplan-Meier plots.

Results

Eighty-eight (N = 88) patients were included in the study, with a mean age of 73. Only 58% of the population studied had pathology specimens confirming the diagnosis; the most common methods of tissue sampling were CT or echographically guided liver biopsy (24%) and cytological brushing of the bile duct during ERCP (20,5%). The mean age of patients for whom tissue was obtained was significantly lower (68 years vs 78 years) than those whose diagnostic was not confirmed pathologically. The mean survival rate for patients was 310 days. We analysed the survival according to the stage at diagnosis; we compared patients with stage I to III cancer (N = 35, 40%), to patients with stage IV cancer (N = 53, 60%). The difference between median survival was not statistically significant between the two groups (286 days vs 158 days, p = 0,115). To analyse the effect of treatment on survival rates, we divided the patients into four different groups; the first group had no treatment (N = 64), the second group had chemotherapy alone (N = 15), the third group had surgery alone (N = 6) and the forth group was composed of patients who had both surgery and chemotherapy (N = 3). The survival was significantly different between group one and two; patients receiving no treatment had a median survival rate of 105 days (77 to 132), while patients treated with chemotherapy alone had a median survival of 496 days (345 to 646) (105 vs 496, p < 0,001). Surgically treated patients (group 3 and 4) seemed to differ from the other groups in terms of survival (434 and 739 days, respectively) but didn't reach statistical significance, probably because of the small sample size of these groups. Finally, to provide a more comprehensive analysis of our results, we compared the treatment groups according to mean age; on that aspect, patients of group 1 were significantly older than patients of group 2 (75 vs 60 years respectively, p < 0,001).

Conclusion

The review of our local experience with cholangiocarcinoma confirms its lethality and its tendency to be diagnosed at an advanced stage. Chemotherapy alone demonstrated a significant benefit in terms of survival, but the significantly younger age of patients in this group seems to be an important confounding factor in our study. Also, the small number of patients treated with surgery probably explains why we were unable to demonstrate a benefit in terms of survival in the surgical groups.